The Future Generations Commissioner for Wales, Derek Walker, is challenging Welsh Government to protect and ringfence prevention funding in all future budgets. 

In a letter to the Finance Minister, Mark Drakeford, which is supported by the Welsh NHS Confederation and the Health Foundation, the commissioner says each Welsh Government department should have funding that is ringfenced for prevention.  

Such funding needs to increase year on year if we are to meet the challenges in front of us such as the rise of obesity, our ageing population and climate change. 

The letter reads: “Current fiscal frameworks do not distinguish clearly between spending on acute services and prevention, despite the evidence that investment in prevention can deliver greater long-term return. Without action, spending on prevention will continue to be a casualty of intense pressures on day-to-day budgets and a victim of short-term thinking. This will undermine the Welsh Government’s commitment to taking a long-term, prevention-led approach to improving public services which is a duty under the Well-being of Future Generations Act.” 

Examples of prevention include breastfeeding support programmes, which can help save the NHS £50m a year, according to a new report by Public Health Wales, and primary care support, such as self-referral to physiotherapy which can create a return of £7.52 for every £1 invested. Or looking at social return on investment in prevention, Sports Wales demonstrated that for every £1 invested in sport in Wales in 2021/22, £4.44 worth of social impacts are generated. 

Sixty two per cent of adults in Wales are overweight or obese (25% reported living with obesity), according to the National Survey for Wales.  

Thirty two per cent of adults show low mental well-being, only 13% reported a high mental well-being with younger people and those living in deprivation having lower mental well-being as shown in the latest Well-being of Wales report. 

Derek Walker, who has been responding to the latest Welsh Government budget in his role as guardian of future generations, said the health and care sector tell him and his team they are finding it increasingly difficult to deal with the growing  number of patients presenting with preventable illnesses, and that short-term performance measures and annual budgeting are key drivers inhibiting the sector from taking a longer term perspective. 

To drive prevention in investment as well as in assurance and performance mechanisms, he urged a shift to longer-term thinking. 

He said: “We all want healthy lives, a thriving economy and environment. But our health both physical and mental is deteriorating, and so is our environment.

“If we are to face the challenges before us in both the short and long-term we have no choice but to turn to widespread prevention across all government departments as well as throughout Wales at the local level. 

“Not taking a preventative approach to health causes preventable suffering – for example in the high number of people with Type 2 diabetes and has an important economic cost. Prevention is better value for money for NHS Wales and tackles inequalities.

Our current and future generations need an urgent shift to a longer-term approach which includes a stronger focus on prevention, so that we can become healthier and for our environment to thrive now and in the long run, backing away from deeply worrying current trends.”

Director of the Welsh NHS Confederation, Darren Hughes said: “There’s plenty of evidence, including in Public Health Wales’ latest report, to show that investing in preventative programmes offers great value for money, keeps people healthier and addresses inequalities. As well as primary, community, mental health and social care services, this extends to the wider determinants of health beyond the NHS and social care – for example education, housing, fair work, transport and access to green spaces, leisure and the arts. 

Improving population health and wellbeing requires an integrated approach across all public services, all sectors and therefore all government departments. Unless we move away from siloes and short-termism and move towards a collaborative, long-term planning approach, we cannot hope to tackle demand, improve the health of the nation and provide sustainable services for the people of Wales.  

“NHS leaders are committed to working with the government and partners across the public, private and third sectors to collectively tackle these challenges.” 

  • Mr Walker became the Future Generations Commissioner for Wales in 2023 and later published Cymru Can, his strategy for making the Well-being of Future Generations Act work harder. This April he will make recommendations to Welsh Government and other public bodies in his five-year Future Generations Report. 
  • The Welsh NHS Confederation represents the seven local health boards, three NHS trusts and two special health authorities in Wales. They are part of the NHS Confederation and host NHS Wales Employers.